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Recommendations EUROPEAN COMMISSION HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL Scientific Steering Committee OPINION ON THE SAFETY OF RUMINANT BLOOD WITH RESPECT TO TSE RISKS ADOPTED BY THE SCIENTIFIC STEERING COMMITTEE AT ITS MEETING OF 13-14 APRIL 2000 OPINION Animal (incl. ruminant) blood is currently legally fed to animals (including ruminants) after very gentle processes, spread on pasture as fertiliser, or used for other products that may reach man or animals (incl. ruminants). There is some concern that animal TSEs might be spread by these means or through specific blood components or blood based products that are still permitted to enter the market. It is therefore necessary to establish if animal TSEs can be transferred via blood and the SSC was requested to: A. Assess for ruminant blood in general and if possible for each component the risk that it could harbour the BSE (TSE) agent and hence transfer the disease. B. Identify the main ruminant blood-based products that are currently on the market, including products containing ruminant blood or those in which ruminant blood is used in their manufacture. C. Assess for each product, the function of the blood component included and the risk that that product could transfer BSE (TSE) to ruminants. D. Outline possible measures that could mitigate any identified risk, as far as possible together with a (qualitative) assessment of the potential impact of the measure on the risk. In order to answer these questions, a Working Group was created which delivered a detailed report upon which this opinion is based (see attachment). On the basis of this report, the SSC elaborated the following summary account, conclusions and recommendations. Remark: The present opinion does not address the possible risks resulting from the exposure of workers to contaminated material. The SSC is presently preparing Notes on the safe handling, transport and storage of MBM and other bovine derived materials which may be contaminated with BSE or other pathogens. REGARDING EXPERIMENTAL STUDIES ON TSE INFECTIVITY IN BLOOD AND ITS COMPONENTS. The majority of assays of infectivity in blood have been carried out in animals or humans with clinically overt TSE and in consequence there remains substantial ignorance about the early pathogenetic involvement of the blood, especially in the naturally occurring T_BLOOD.doc 2 diseases. In BSE, transmission has not been achieved in the majority of studies either in natural and experimental disease, although recent investigations indicate this possibility. In experimental scrapie, blood components obtained during both the pre-clinical and clinical stages of disease from rodents, have revealed the presence of the infectious agent. The results reviewed in the Working Group Report are consistent with recent data in mice infected with mouse-adapted human TSE, and in hamsters infected with hamster-adapted scrapie. Although reliance upon the results requires an assumption that experimental rodent data can be extrapolated to the conditions of natural disease in humans and other animal species, the data from both experimentally-induced and natural TSE suggest that blood has at least the potential to transmit disease. The reasons for the discrepancy between this laboratory evidence and the epidemiological evidence that has so far failed to identify any blood-related cases of TSE, are probably multiple: the absence of significant blood infectivity until the onset of symptomatic disease, and comparatively low levels of infectivity during the symptomatic stage of disease: the need for 5 to 10 times more infectious agent to transmit disease by the intravenous than intracerebral route. For some blood products, there is a further reduction of infectivity during the course of blood processing (for example an estimated reduction of 3 logs for the "133°C/20'/3bars" treatment). REGARDING SOURCING Slaughtered cattle are used to source blood for food, feed and a variety of other purposes including the manufacture of medicinal products and biologicals. Farmed sheep, goats and deer could supply blood for these purposes. All these species are susceptible to TSE both naturally and experimentally. BSE as a natural disease has only been reported in cattle. The possibility of BSE being in sheep and goats cannot be excluded. Furthermore, one hypothesis for the origin of BSE is from a scrapie-like agent from sheep. It is possible that such a source still exists or that the BSE agent from cattle has returned to sheep and goats. If it exists it may no longer be recognisable if natural sub-passage has occurred. No validated tests exist to detect TSE in live cattle, sheep, goats or deer. Clinical TSE has never been reported in deer in Europe. A post mortem inspection will not enable detection of any TSE in any species and will not improve upon the ante mortem inspection. Close T_BLOOD.doc 3 surveillance for the disease and effective ante mortem clinical inspection of all slaughter animals therefore remain essential. Exogenous contamination of blood with CNS material in the form of emboli (and hence infectivity) is most likely in TSE-infected animals stunned with a stunning pistol that injects gas into the cranial cavity under pressure. This can also occur if a conventional cartridge –fired captive bolt is used in combination with pithing. Exogenous contamination of blood could occur post mortem if SRM are not kept separated from collected blood. REGARDING RISK ASSESSMENT The SSC considers that the most important aspect of risk assessment relates to brain tissue contamination. The SSC proposes a general approach for the risk assessment for blood within a given area, which basically involves 3 aspects: • Slaughterhouse Basically at the level of each individual slaughterhouse, the following risk factors should be recorded: 1) number, species and age of slaughtered animals ; 2) number of potentially infected cows being killed and their brain material entering the bloodstream related to the stunning method used (pneumatic devices, pithing) ; 3) the average amount of blood collected per animal; 4) the dilution by pooling blood from several animals; 5) the amount of such collected blood going to the industry to be processed for human or animal consumption. • Geographical BSE risk and surveillance For the geographical BSE risk and surveillance reference is made to the SSC opinions adopted sofar by the SSC. • The use of blood At present, blood collected hygienically in licensed EU abattoirs can be used for food, feed and a variety of other purposes without any form of processing. For example, it is permissible to incorporate fresh untreated plasma into the materials used for the T_BLOOD.doc 4 production of sausages, and can be spread on land as a fertiliser. Elsewhere, in this opinion, it is concluded that there could be a risk of the occasional presence of low levels of TSE infectivity in blood collected in abattoirs. Levels of infectivity which might represent a risk to animal or human health are not known. Control measures and/or decontamination standards might need to be developed to potentially TSE-infected blood collected in abattoirs. There is insufficient information on the nature of usage of blood and the resulting blood- products obtained from abattoirs within the EU. The situation is further complicated by the fact that the names used to describe identical or similar products in different countries can be quite different. From the limited information available on the manufacturing processes for blood-products, the most rigorous methods applied would appear to involve coagulation of the blood at 95-100oC, followed by spray-drying during which the end- product reaches a temperature of 110oC. Several sets of data indicate that this process is unlikely to result in any significant reduction in the titre of TSE infectivity. The alternative is to either apply risk-assessment techniques or, where practicable, adopt the rule that products should be subjected to the "133oC/20’/3bars" standard. The latter approach is applicable only to some products. At the level of processing of blood for human and/or animal consumption, risk can be further evaluated in respect to (i) the amount of brain material actually entering the bloodstream following the use of invasive stunning devices. Neither its volume range nor the range of particle size is known. Likewise, no quantitative estimates are available on contamination of blood with SRM materials during the slaughtering process other than by stunning the animals. (ii) dilution of CNS material resulting from the emboli and (iii) the efficacy of the various processing steps in respect to inactivating the BSE agent. There is little doubt that under certain circumstances, humans or animals could be exposed to the BSE agent by consuming blood products. T_BLOOD.doc 5 C ONCLUSIONS The collective data currently available from experimental transmission studies show that there is uncertainty on the presence of infectivity in the blood of TSE-infected ruminants. If PrPSc has been detected in the blood of clinically normal sheep from scrapie-susceptible flocks using a newly-developed and highly sensitive assay system, infectivity of femtomole amounts remain to be demonstrated. The relationship between PrPSc and infectivity is not understood. The two do not always correlate; the presence of PrPSc does not necessarily imply presence of infectivity. Moreover, the methods for detecting PrPSc need to be validated for the pre-clinical stage. As far as ruminant blood is concerned, it is considered that the best approach to protect public health at present is to assume that it could contain low levels of infectivity. However, even if this is true, it becomes almost irrelevant compared with the level of contamination that could occur as a result of the methods of stunning used in abattoirs. These procedures are now recognised to release particles of brain-tissue (potentially containing high titres of TSE infectivity) into the bloodstream. The frequency at which this occurs appears to increase with the severity of the stunning process, and this report recognises that this is an area requiring further research.
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